As I write this, a front page story in the New York Times1 is reporting a population based study that followed smokers who had recently quit.2 The takeaway message is that “the nicotine gum and patches that millions of smokers use to help kick their habit have no lasting benefit and may backfire in some cases.”1

Wow, really? I’m all for evidence based medicine and evidence based public health (and evidence based everything, I guess), but is this conclusion really justified?

Before we take a look at the study, a few background notes. Tobacco use remains the leading cause of death in the United States, responsible for one in five deaths, around 440 000 a year.3 Smoking is addictive; most smokers are dependent on nicotine.4 Nicotine replacement therapy, introduced in 1984, is now available in multiple forms: gum, lozenge, patch, inhaler, and nasal spray, the first three of which are sold in the US without a doctor’s prescription. A huge number of well done randomised controlled trials and meta-analyses in the clinical setting …